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Background: The standard five-stage clinical systems of Tanner and Marshall for assessing pubertal development are limited by observer variations. The measurement of testicular volume, in addition, will make assessments objective. It is important to determine the mean testicular volumes (MTVs) for a given population as reference standards. Aim: To determine the MTVs in children between 8 and 17 years and to compare the MTV with Tanners staging. Methods: A cross-sectional study was conducted on 750 healthy school boys from 2 schools in Chennai between 8 and 17 years of age by a single observer to reduce the observer variation. Tanner’s staging and testicular volume measurement were done using a Prader’s orchidometer. Results: Of the 750 boys studied, the MTV of both the right and left testes was found to increase from 2.47±0.70 cc at 8 years of age, to 3.84±1.91 cc at 12 years, to 15.93±6.65 cc at 17 years of age (p=0.0001). The mean age was found to be increased from 12.69 years at sexual maturity rating (SMR) Stage-2, to 15.66 years at SMR Stage-5. We found a significant positive correlation between SMR and height (p=0.0001), weight (p=0.0001) and body mass index (p=0.0001). The average size of both the right and left testes was found to be increased from 2.86±1.12 cc at SMR Stage-1 to 12.51±4.67 cc at SMR Stage-3 to 18.90±4.64 cc at SMR Stage-5. In our study, 0.5% (n=4) had an MTV of 4 cc at the age of 8, 0.4% (n=3) had an MTV of <4 cc by the age of 14. Conclusion: The measurementof MTV along with Tanner’s SMR staging makes the assessment of male genital development more objective and acts as a measure of testicular growth and spermatogenesis. Generating a baseline data on age appropriate testicular volume in a population or ethnic group is essential to assess sexual developmental disorders among males.

Childhood pneumonia has a myriad of disease causing organisms. Identifying the etiology often helps us predict the natural course of the illness. We would like to share an interesting child with pneumonia by the hematological manifestation of the disease. Case report of this study is a 8 year old boy who presented with high grade fever for eleven days associated with cough. History of skin rashes which worsened following therapy with penicillin. On Examination child had maculopapular rashes predominantly over the trunk with decreased air entry in the left hemithorax. Chest x-ray done showed left lower lobe consolidation hence treated with cephalosporins and macrolide. Counts revealed falling trend in haemoglobin with high MCV count. Peripheral smear done showed agglutinated RBC’S and occasional nucleated RBC’s. Direct Coombs test was positive. With these haematological manifestations child was diagnosed to have Mycoplasma pneumonia which was proven by positive antibodies against Mycoplasma. Child recovered completely and haematological manifestations became passive after four weeks. Cold agglutinin disease is poorly understood affecting 15% of patients with Autoimmune hemolytic anemia. Respiratory tract involvement and extrapulmonary complications manifest in 3-10% and 25% respectively. Antibodies (IgM) against the I antigen on human erythrocyte membranes appear during the course of M. pneumoniae infection and produce a cold agglutinin response. AIHA typically occurs during 2-3rd week after febrile illness with sudden onset of hemolysis which is self-remitting within 4-6 weeks. The conclusion of this study is extra-pulmonary manifestations in a child with pneumonia help in diagnosing the etiology. This in turn helps us like provide rationale management and Predict the natural course of the illness.

West syndrome (WS) is a rare, severe form of epilepsy with onset in infancy and early childhood. It involves clustered epileptic spasm episodes, the aberrant interictal electroencephalogram pattern known as hypsarrhythmia, and neuropsychomotor delay. In this view, we present a case of a 6-year-old female child a known case of west syndrome, global developmental delay, hypothyroidism, and post-operative laparoscopic gastrotomy performed under general anaesthesia on March 31/2022, in view of recurrent aspiration and came with the chief complaints of seizure 6-7 episodes per day, decreased urine output, constipation for two days, straining to pass urine, and three episodes of vomiting. The history included that the baby cried immediately after birth, seizure on day 5 of life, and was shifted to the Neonatal intensive care unit (NICU), admitted there for 5 days because of respiratory distress syndrome and hyperalbuminemia. During their stay in the hospital, the child has been prescribed Lamotrigine 50mg, Levocarnitine 500mg, Levetiracetam 250mg, Clobazam 5mg, Phenobarbital 60mg, Sodium Valproate 100mg, Thyronorm 50mcg. Now the patient is symptomatically better. This case report intends to sensitize physicians in this region toward this rare neurological syndrome. Keywords: Hypsarrhythmia, Infantile, Seizure, West syndrome.